Evaluation of the patient with incontinence

Abstract

The incontinent patient is evaluated in order to make a presumptive diagnosis so that treatment can be offered. The evaluation begins with a history and a physical examination. The history focuses on the description of the patient's incontinence. Assessing the patient's bother and determining their expectations of treatment may further guide how aggressive one needs to be both with the evaluation and the presentation of treatment options. The important parts of the physical exam are an examination of the abdomen and pelvis including a provocative stress test. A urinalysis and a post-void residual (PVR) should be performed in all incontinent patients. Incontinence questionnaires, voiding diaries, and pad weight tests can provide more objective data than the history alone. Upper tract imaging is indicated in the patient with a history of hematuria and in patients with suspected hydroureteronephrosis. Other imaging may be useful to further evaluate other suspected pelvic pathology. Urodynamics are performed to determine if the incontinence is due to bladder or urethral dysfunction or both, to assess if the patient has a storage or emptying problem and lastly in an effort to identify patients whose upper tracts are at risk due to high bladder storage pressures. Cystoscopy is indicated in the work up of some incontinent patients. The evaluation of the incontinent patient consists of a history, a physical, urinalysis and a post-void residual. Optional evaluative tests consist of a variety of urodynamic tests, imaging studies and cystoscopy.